{"id":"dc8a8f3fd6b4","type":"article","url":"https://hartvaat.nl/2016/06/21/strategieen-om-microvasculaire-obstructie-te-verminderen-bij-primaire-pci-relief/","title":"Strategieën om microvasculaire obstructie te verminderen bij primaire PCI: RELIEF-MI-trial","title_en":"Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","farmaco-economie","microcirculatie","ouderen","secundaire-preventie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw136","source_url":"https://doi.org/10.1093/eurheartj/ehw136","authors":["Sheraz A Nazir","Gerry P McCann","John P Greenwood","Vijay Kunadian","Jamal N Khan","Islam Z Mahmoud","Daniel J Blackman","Martin Been","Keith R Abrams","Lorraine Shipley","Robert Wilcox","A A Jennifer Adgey","Anthony H Gershlick"],"significance":6,"published":"2016-06-21","source_date":"2016-06-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This randomized trial tested local adjuvant therapies to reduce microvascular obstruction during primary PCI for STEMI, exploring whether intracoronary treatments can improve myocardial salvage beyond mechanical reperfusion alone.","created":"2026-07-03T10:26:11Z","updated":"2026-07-03T13:25:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial naar lokale adjuvante therapie ter vermindering van microvasculaire obstructie tijdens primaire PCI bij STEMI. Onderzocht of lokale behandeling de no-reflow na reperfusie kan beperken.","abstract_original":"BACKGROUND: Microvascular obstruction (MVO) following primary percutaneous coronary intervention (PPCI) treatment of ST-segment elevation myocardial infarction (STEMI) contributes to infarct expansion, left ventricular (LV) remodelling, and worse clinical outcomes. The REFLO-STEMI trial tested whether intra-coronary (IC) high-dose adenosine or sodium nitroprusside (SNP) reduce infarct size and/or MVO determined by cardiac magnetic resonance (CMR). METHODS AND RESULTS: REFLO-STEMI, a prospective, open-label, multi-centre trial with blinded endpoints, randomized (1:1:1) 247 STEMI patients with single vessel disease presenting within 6 h of symptom onset to IC adenosine (2-3 mg total) or SNP (500 μg total) immediately following thrombectomy and again following stenting, or to standard PPCI. The primary endpoint was infarct size % LV mass (%LVM) on CMR undertaken 24-96 h after PPCI (n = 197). Clinical follow-up was to 6 months. There was no significant difference in infarct size (%LVM, median, interquartile range, IQR) between adenosine (10.1, 4.7-16.2), SNP (10.0, 4.2-15.8), and control (8.3, 1.9-14.0), P = 0.062 and P = 0.160, respectively, vs. CONTROL: MVO (% LVM, median, IQR) was similar across groups (1.0, 0.0-3.7, P = 0.205 and 0.6, 0.0-2.4, P = 0.244 for adenosine and SNP, respectively, vs. control 0.3, 0.0-2.8). On per-protocol analysis, infarct size (%LV mass, 12.0 vs. 8.3, P = 0.031), major adverse cardiac events (hazard ratio, HR, 5.39 [1.18-24.60], P = 0.04) at 30 days and 6 months (HR 6.53 [1.46-29.2], P = 0.01) were increased and ejection fraction reduced (42.5 ± 7.2% vs. 45.7 ± 8.0%, P = 0.027) in adenosine-treated patients compared with control. CONCLUSIONS: High-dose IC adenosine and SNP during PPCI did not reduce infarct size or MVO measured by CMR. Furthermore, adenosine may adversely affect mid-term clinical outcome. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01747174; https://clinicaltrials.gov/ct2/show/NCT01747174."}